The 2018 Opioid Bill

October 25, 2018

The 2018 Opioid Bill: What’s in it? What is missing?

The United States Congress reconciled both House and Senate opioid bills aimed at
reducing the deadly toll of the nation’s top health care crisis: the opioid epidemic.
In the SUPPORT For Patients and Communities Act, Republican and Democrat
lawmakers came to a rare agreement between both parties. The drug overdose
epidemic claimed 72,000 lives in 2017 alone and roughly two thirds of those deaths
were from prescription and non-prescription opioids. The bill will now head to the
Senate as the House of Representatives almost unanimously passed the bill in a rare,
393-8 vote. President Trump is expected to sign this legislation into law before the
midterm elections. This is a fairly large bill, that will cost the US billions of dollars
but many argue that the bill doesn’t do enough to address the nation’s greatest
public health issue. Senator Elizabeth Warren has proposed a bill that would cost
the US tax payer $100 billion over the next 10 years, as she argues this is what is
really necessary to fully address the opioid crisis.

The SUPPORT for Patients and Communities Act takes a wide approach to theopioid epidemic from law enforcement, treatment and public health caremeasures.

We will talk about some of the major policy changes in the bill and the full-text of
the bill is available here.

One of the greatest achievements of the new bill is a provision to allow Medicaid
recipients to seek care at addiction treatment centers. The restrictions on Medicaid
funding for substance abuse treatment had been long outdated and congress finally
addressed this problem. Allowing Medicaid to help fund up to 30 days of inpatient
rehab stays, including medication-assisted treatment (MAT) is going to help a lot of
people get the help they desperately need. The bill authorizes a grant program
through the Substance Abuse and Mental Health Services Administration (SAMHSA)
to help communities develop opioid recovery centers. While the bill does address
the lack of funding for increased access to treatment programs, many addiction
specialists argue the bill does not do enough in this regard. While noting that the bill
is not itself bad as it does a lot to address a multitude of issues, it is severely lacking
on access to treatment, which many believe is the most important technique that
could help solve the opioid crisis.

Another provision in the bill lifts restrictions on medications used to treat opioid
use disorder and other types of addiction. This measure simply allows more medical
practitioners to prescribe medications such as buprenorphine, used to help ease
withdrawal symptoms in addiction recovery. As it stands today only 5 percent of
doctors are licensed to prescribe this life-saving drug. Another medication, naloxone
was addressed in this bill. One provision allows first responders greater access to
the life-saving opioid antagonist which can reverse the effects of an opioid overdose.

The major law enforcement provision of the SUPPORT Act is aimed at the trafficking
of drugs through the postal system. Fentanyl that is illegally imported from Mexico
and China has been blamed for many of the opioid-related deaths in recent years.
One package seized in Philadelphia last June contained 110 pounds of fentanyl,
valued at $1.7 billion dollars. This was estimated to be enough of the dangerous
substance to kill the entire population of the state of Pennsylvania two times over.
Fentanyl is 50 times more potent than heroin, so it is easy to smuggle large amounts
of the substance through the mail system. This bill makes it harder for people to
sneak illicit substances into the US from abroad. The bill will require packages
coming in from foreign countries to reveal their contents and where and who
they’re coming from. While the bill is broadly aimed at targeting illicit drug
suppliers, it includes protection for individuals looking to import cheaper
prescriptions from overseas. This was in direct opposition to pharmaceutical
companies’ requests to include enforcement against importing cheaper
prescriptions from other countries.

While the SUPPORT for Patients and Communities Act does a lot to fight the opioid
epidemic, there is still a lot of work to be done in the near future. The bill even
authorizes research into opioid alternatives to pain management and penalizes drug
manufacturers and distributors for overprescribing. A lot more could have been
done to address the root causes of addiction and it should have offered greater
access to outpatient treatment programs. However, while a lot of divisive partisan
issues like funding were ignored in the bill, the Democrats and Republicans agreed
on a lot of ‘second-tier’ issues that will definitely help save lives. Given the extreme
divisiveness in American politics in the Trump era, this is a small political victory.
Thankfully, everyone finally seems to want to work together in fighting this urgent
national health crisis.